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Provider Path · Free forms & records guide

Iowa child care paperwork.

The Child Care Provider Portal supports child development home registration, renewals and Child Care Assistance transactions. Healthy Child Care Iowa publishes detailed health and incident forms.

Agency: Iowa Department of Health and Human Services (HHS)
Paperwork source review: September 14, 2026

Use your print window to print on paper or save as a PDF. The organizer is a planning aid for your files.

Check the form and your provider type.

An official agency form is issued or listed by the agency; that label alone does not establish mandatory use. A required state form is identified as mandatory in the cited instructions. A required record identifies information you must maintain; its format may be flexible. An optional template is a suggested format. Official instructions / portal links explain the application or record process.

Read “Applies to” and “Format and applicability” for each item. Home, group-home, center, local licensing, food-program, and subsidy requirements can differ.

Application & renewal

01
Official instructions / portal

Child Development Home registration, renewal and change portal

Apply, renew or change a child development home registration.

Applies to
Registered child development home applicants and existing providers
Who completes it
Provider
Where it goes
Child Care Provider Portal.
When to use or update
Initial registration, renewal or a registration change.

Format and applicability: Public landing page; account needed for provider transactions.

Open official source: Iowa Child Care Provider Portal ↗https://ccmis.dhs.state.ia.us/ProviderPortal/

Children’s files

02
Official agency form

Infant, Toddler, Preschool Age Child Health Form

Form 470-0221

Documents health assessment, care restrictions and parent health information.

Applies to
Infants through preschool, including kindergarten entry
Who completes it
Health professional completes examination page; parent/guardian completes history
Where it goes
Parent provides to the child care program.
When to use or update
Parent/guardian section is marked for annual completion; verify clinical examination timing separately.

Format and applicability: Official PDF; no claim that all providers must use this exact layout.

Open official source: 470-0221, revision 09/25 ↗https://hhs.iowa.gov/media/18166/download?inline=
03
Official agency form

School-Age Child Health Form

Form 470-0222

Records school-age health needs, medications and examination findings.

Applies to
School-age children in care
Who completes it
Parent/guardian and health professional
Where it goes
Child's health file.
When to use or update
Annual parent history per form; clinical timing must be checked separately.

Format and applicability: Two-page PDF; directory's older 'Parent Statement' label does not describe all current pages.

Open official source: 470-0222, revision 09/25 ↗https://hhs.iowa.gov/media/18167/download?inline=
04
Official agency form

Medication Authorization and Record

Links written permission with dose, timing, route, storage and administration records.

Applies to
Early care and education programs administering medication
Who completes it
Parent authorizes; person administering documents doses
Where it goes
Attach completed medication records in the child's file.
When to use or update
Before administration and for each administration; form organizes authorization by month.

Format and applicability: Official two-page PDF, HCCI 06212023; exact-format mandate not established.

Open official source: HCCI Medication Authorization and Record ↗https://hhs.iowa.gov/media/2872/download?inline=

Safety & daily records

05
Required record

Child Care Injury/Incident Report

Form 470-0121

Documents injuries requiring first aid or medical care and serious incidents.

Applies to
Child care homes, child development homes and licensed facilities
Who completes it
Provider; parent/guardian acknowledges
Where it goes
Keep incident documentation; email serious injury/death report to ccsid@hhs.iowa.gov.
When to use or update
Complete after qualifying injury; serious injury or death is reportable within 24 hours.

Format and applicability: Three-page official PDF with parent and provider signature sections.

Open official source: 470-0121, revision 07/25 ↗https://hhs.iowa.gov/media/15928/download?inline=

Provider & staff files

06
Official agency form

Child Care Provider Physical Examination Report

Form 470-5152

Documents health assessment, baseline TB screening and ability to provide care safely.

Applies to
Child development home providers and child care center personnel
Who completes it
Health care professional
Where it goes
Provide to the program/registration worker under licensing instructions.
When to use or update
For required staff/provider examination; renewal interval not established by this form.

Format and applicability: Two-page PDF; it distinguishes TB screening from testing.

Open official source: 470-5152, revision 01/23 ↗https://hhs.iowa.gov/media/5812/download?inline=

Food program & subsidy

07
Official instructions / portal

CCA provider agreement, attendance and payment portal

Manage CCA agreement, eligible attendance entry and payment requests.

Applies to
Providers applying to serve CCA families or already participating
Who completes it
Provider
Where it goes
Child Care Provider Portal.
When to use or update
On joining CCA, when agreement changes, and during payment reporting.

Format and applicability: Account required; transaction instructions are inside the portal.

Open official source: Iowa Child Care Provider Portal ↗https://ccmis.dhs.state.ia.us/ProviderPortal/

What this review covers

Selected official forms and public instructions were reviewed on September 14, 2026. This is a practical starting list, not a complete certification of every record, retention period, local rule, or individual application.

  • Portal landing page retains DHS branding but the current HHS provider page links it.
  • Mandatory exact-format use was not established for the general health forms.
  • Medication and clinical-health requirements should be checked with the current HHS child care nurse consultant or licensing/registration worker.

Use the agency’s current original and revision instructions. Keep confidential child and staff records in your own secure record system.

Report a changed form or link →

Provider Path · Reusable planning companion

Iowa paperwork organizer

Use this sheet to check which items apply to your program. A listed item or a checked box does not establish that your program meets licensing requirements.

Program / provider type:

Licensing office / reviewer:

Date checked / rule or packet edition:

Form or instructionApplies?
Yes / No / Ask
Received / completedLocation / next review
1. Child Development Home registration, renewal and change portal
2. Infant, Toddler, Preschool Age Child Health Form (470-0221)
3. School-Age Child Health Form (470-0222)
4. Medication Authorization and Record
5. Child Care Injury/Incident Report (470-0121)
6. Child Care Provider Physical Examination Report (470-5152)
7. CCA provider agreement, attendance and payment portal
Other local or agency document
Food-program / subsidy documents

Questions and next steps

Ask about required format, signatures, submission, update triggers, and retention. Record the agency’s answer and the person or written source that confirmed it.

Companion to the Iowa source review dated September 14, 2026. Provider Path educational planning sheet.